Heart transplants still face many obstacles in Japan

TOKYO (AP) _ Performing his country’s first heart transplant made him an instant hero. Then it made him a murder suspect.

Nearly 30 years later, Dr. Juro Wada still is cited by Japanese looking for examples of why doctors _ and the establishment in general _ should not be trusted.

His first heart transplant also was Japan’s last. And it comes up often in the public debate over whether to rewrite a strict definition of death that results in Japan being the only industrial nation where doctors are unable to obtain viable hearts, livers and lungs for transplant.

When he carried out his Aug. 8, 1968, operation, Wada drew headlines and adulatory comparisons to TV’s heroic Dr. Ben Casey. But reactions quickly soured when the patient died 83 days later. A group of herbal doctors demanded a criminal investigation.

While Wada was never charged, the prosecutors’ investigation discovered he had kept no records of the heart donor’s brain waves, which would have proved the patient was clinically dead when the organ was removed.

A witness said the donor was still breathing on his own at the time the heart was removed. Another doctor said the 18-year-old recipient hadn’t really needed a transplant.

After the operation, a section appeared to be missing from the recipient’s old heart, and one valve was suspected of being from a totally different heart. That raised suspicions Wada might have tampered with the heart to exaggerate the recipient’s ailment.

Wada, now 75, still works as a doctor and denies he did anything wrong. He rarely speaks to the press, but in an interview with The Associated Press he said his only regret was that no other doctor followed his example.

``He was a lovely young man,″ Wada said of the heart recipient. ``He was so happy. The outcome was short, but he had a rich, wonderful life.″

Under current Japanese law, death is defined as the moment at which the heart stops beating. At that point, kidneys and corneas are still usable in transplants, but the heart, lungs and liver deteriorate too much.

By contrast, the United States and other countries where transplants are routine define death as the absence of brain activity, which often occurs before the heart stops beating. Machines can keep a body’s blood pumping after brain death, thus keeping organs in good condition for transplant.

Legislation to recognize brain death and open the way for transplants failed last year in the Diet, Japan’s parliament. This April, the lower house passed a bill that would allow the brain death standard to be used for transplant donors _ provided donors had left written consent for their organs to be used in transplants. But the bill stalled in the upper house.

Now, legislative leaders have worked out a version that would allow family members to overrule a doctor’s diagnosis of brain death. The upper house is scheduled to vote on the bill Monday, and if it passes, the lower house would be expected to adopt it before the legislative session ends Wednesday.

But changing the law might not change the transplant situation. Opinion polls say Japan is deeply divided on transplants.

Japanese cultural beliefs about death is one obstacle. Some people think cutting open a corpse or taking away organs hurts a person after death.

But the most pervasive obstacle is a deep-rooted suspicion of the medical establishment.

Traditionally powerless before politicians, bureaucrats, bosses at work and other authority figures, Japanese are nervous about being kept in the dark about dangerous decisions, even if most feel they don’t have the right to question their doctors. That fear is especially pronounced when the decisions involve death.

``I think transplants are sometimes a way for surgeons to show off,″ said a housewife, Eiko Mizuno.

The medical establishment’s reputation was further damaged recently by a scandal involving government health officials and doctors who knowingly used blood products tainted with the AIDS virus, causing the deaths of some 400 hemophiliacs. A prominent doctor is being tried on criminal negligence charges in that case.

In a recent editorial, the national newspaper Asahi said organ transplants will never be accepted in Japan unless hospitals start practicing ``medicine that patients can trust.″

Doctors and patients must be on an equal footing, and the informed consent of patients as well as a more open, fair system of treatment must be guaranteed, it said.

Such concepts are alien to many in Japan.

Many doctors refuse to even tell patients when they have cancer or other serious illnesses. Malpractice lawsuits are rare.

Surgeons routinely accept cash gifts from patients, in addition to regular billing, and are believed to award better treatment to those who give the bigger gifts.

``In Japan, doctors are still viewed as way above their patients,″ said Katsunori Honda, a Tokyo University Hospital doctor.